What I wish I knew before starting fertility treatments

Aparna Lekhi* got a copper IUD inserted into her uterus as a contraceptive when she was 20. “I was married at 23. My husband and I decided on a five year period of building a life together before bringing children into it.” At 28, Lekhi got the IUD removed to conceive and start a family. After close to two years of trying to conceive, they went to a specialist who put them both through a round of tests. “His family is very conservative and the fact that we weren’t having children right after our wedding was hard enough for them to accept. When talk of starting fertility treatments became public, I was blamed.”

Tests showed that her spouse had abnormal sperm function. Their families still blamed the IUD, even when every doctor they’d spoken to agreed it had no negative impact on long-term fertility.

Looking back, she says, there are things she would have done differently had she known how to soften the blow that starting fertility treatments can have on your life. This sentiment was echoed by other women we spoke to. They open up about their experiences and share what they want others to know and be prepared for.

“It’s not to scare anyone,” says Lekhi. “Even when you know what to expect, it can be a difficult experience, but at least you have a plan of action.”

What to know before starting fertility treatments

“Even the strongest of relationships can take a hit”

Married for eight years, 37-year-old Candida and Simon Fernandes had been trying to conceive for four. “We tried to have babies right away. After two frustrating years, we opted for In Vitro Fertilisation (IVF) and that was a rollercoaster,” she says. The injections hurt, the hormones made her emotional. They had to be each other’s support system, while the taanas kept coming from her in-laws.

Given that 10% – 14% of the Indian population faces infertility issues, you’d think as a society, we’d have a better understanding of it.

None of their friends could relate to their experience, and their anger often targeted each other. The schedule, appointments and constant monitoring made sex more of a chore. “Two cycles failed and he pushed for a third. I didn’t think I could handle it – emotionally or physically. But after some talking, we agreed that this would be our last try.” Today they have a healthy little girl.

“We went into this hand in hand but intimacy felt like doing homework for your least favourite class. There was resentment we both felt towards each other from time to time, especially after two IVF failures,” adds Simon.

The stress of the process can drive a wedge between partners. The Fernandeses say it was easier to let go of each other’s past actions when they did finally manage to conceive. “I don’t know if I would be saying the same if the third attempt also failed,” says Candida.

“Find support outside of the family — a group or therapist to guide you”

“Counselling is an integral part of the fertility journey. Each couple should be counselled meticulously before, during and after their treatment about the possible failures. This helps them cope emotionally and remain positive throughout the process,” says Dr Hrishikesh Pai, leading gynaecologist, infertility specialist and one of the founders of Bloom IVF Group.

There are a number of support groups across the country run by individuals in digital spaces like Facebook and Whatsapp where you can connect with people going through the same experience. A lot of fertility clinics also have support groups you can join.

Psychologist Paramjit Soin suggests finding a therapist at the same time that you’re starting fertility treatments. “The process makes you very vulnerable and there’s a lot of pressure on the women to perform, even when things are out of their control.”

She’s seen patients break down, fearing their partner will leave them if the treatment isn’t successful. Some marriages reach a breaking point under this much pressure. The most common issue is that the couple loses the ability to talk to each other without breaking into arguments.

She recommends keeping a communication journal. In this, both partners have separate sections in which they can write messages to the other. Things that you’re struggling to say out loud, but may find easier to put down in words.

Counselling is something both couples need to attend together. “Starting it together will keep you both on the same page, maintain a strong relationship and be able to face those challenges together rather than play catch up and/or do damage control later.”

It’s important to find other activities you can do together where talks about baby-making are off-limits. “Fertility treatments can take over a large part of your life, but they cannot become your entire life. It makes it that much harder to move on together if it doesn’t succeed”

“Build a savings account for fertility treatments before starting”

On top of the anxiety of not getting pregnant, there’s also the financial aspect to consider before starting fertility treatments.

Not all treatments are heavy on the pocket, says Dr Molina Patel, infertility specialist and aesthetic gynaecologist, Akanksha Hospital, Gujarat. “While most couples will need only basic tests/investigations and medicines to get pregnant, it is the Assisted reproductive techniques (ART) like IVF or Intracytoplasmic Sperm Injection (ICSI) that are relatively expensive.”

Most standard health insurance is unlikely to cover fertility treatments. Speaking to your insurance provider will give you a clearer picture of what you can and cannot claim under your insurance policy.

As much as we hate reading any Terms & Conditions, look at the terminology used in your policy: full infertility coverage, no fertility coverage, coverage for infertility diagnosis only, coverage for infertility diagnosis and limited fertility treatment and medication coverage – this may or may not include prescription fertility drugs. You also need to find out how many cycles they’re willing to cover.

“In India, around 4-5 government hospitals offer free IVF treatment but couples still have to spend for medicines up to ₹50,000. The majority of the couples pay from their own pockets and the cost of an IVF cycle ranges between ₹1 lakh – ₹1.5 lakhs including medicines. There are many banks and non-banking financial companies (NBFCs) who are providing EMI facilities to patients with low-interest rates,” says Pai.

Naina Mukherji and her husband dipped into their savings to pay for their treatment and ended up taking out a loan as well. The clinic they chose also had its own long-term payment plan that enabled them to spread out payments and financially sustain themselves through the pregnancy. Many hospitals and clinics offer different payment plans and policies to ease the financial strain, like Pai’s Bloom IVF Group. This is a factor Mukherji says to consider before choosing a clinic for treatment.

“Consider freezing your eggs so there are no regrets later, it’ll also improve your chances of conception”

While we’re busy climbing the corporate ladder, setting down roots in a new city and finding a partner, that damn biological clock keeps ticking.

“You may think you don’t want children now, but there is always a possibility in the future. Like a lot of young women at the time, I was rebellious, saying no to everything considered ‘traditional’ for a woman to do – no to marriage, no to kids. But things change, circumstances change and so do your life goals,” says Priyanka Naithani.

Naithani froze her eggs when she turned 34, much to her parent’s disapproval. “They still think it was so unnatural. ‘If you want children why not just have them now?’ they’d say. I wasn’t ready to get married. They certainly weren’t ready for me to have a baby without marriage!” she laughs.

Now 38 and married, Naithani is undergoing her first round of IVF.

Getting pregnant after 30 is becoming commonplace but we can’t ignore the risks and challenges. The older we get, the more physically taxing pregnancy and raising a child can be on the body. Fertility peaks between the age of 24-34. “At 30 years, 30% of our eggs will be abnormal, at 40 years, the number goes up to 60%. At 40, our AMH (Anti-Müllerian hormone), which is the mark-up for the number of eggs, comes down,” says Dr Firuza Parikh, director of the department of assisted reproduction and genetics, Fertiltree – Jaslok International Fertility Centre.

When you’re ready to have a baby, the lab will fertilise your eggs with your partner’s sperm and these will be put into you (IVF).

This is a costly procedure, with hospital charges coming up to Rs 1 lakh. The medication can cost anywhere from ₹30,000 to ₹80,000. The freezing charges come to ₹20,000 to ₹40,000 per year, depending on how many eggs are frozen. The procedure is not 100%, even if it’s done in the best of conditions. Freezing your eggs doesn’t guarantee conception — but it does increase your chances.

Patel says that freezing your eggs can reduce the “fertility anxiety ” that many women face. “Knowing that you have a batch of good quality, young eggs frozen as back-up gives a sense of relief and relaxation. It removes that pressure of declining fertility while the woman is actually trying to progress in her career.”

“Telling my boss about my treatment took a weight off my shoulders”

Fertility treatments will require a certain number of visits to the clinic. Follow-up consultations, check-ups and blood work. Constantly dipping out of the office to get an embryo transfer or feeling particularly emotionally drained one day while having to prepare for a team meeting – your work-life balance can be seriously put to the test during this time.

While some manage to do it all, others fumble to separate the different aspects of their life. Preeti managed to hold it together for about half her IVF treatment before she felt it take a toll on her professional work. “I would be nauseated, had some bad bruising at the injection site that made it difficult to sit sometimes, and was running out of excuses. I took a lot of sick leave, and of course, my manager started to get irritated by my absence too,” she says.

With her husband’s encouragement, she approached her manager for a sit-down to discuss what she was going through. “I got very lucky, she understood my experience and made a new schedule where I could do some work from home and dropped me from assignments that were time-sensitive. I compensated by helping in other areas where I would be able to manage.”

Most clinics will help you create a schedule around work engagements but sometimes the overlap is unavoidable. While she had been lucky to have an understanding boss, not everyone will. Maybe you’re just not comfortable sharing private information in a professional setting.

“If you have a friendly relationship with supervisors, it’s easier to share these things and ask for a little leeway. This is a medical treatment after all, so you are eligible to take medical leave,” says Soin.

If you’re not ready to spill the beans on your fertility journey, then she suggests telling them you are undergoing medical treatment but keep the details to a minimum. “Approaching them with a plan will make them more receptive to what you’re asking for. Tell them the treatment will require you to see the doctor on X and Y days. Explain how you can manage your workload, divide your time in the office or after hours to make up for lost time and meet deadlines.”

“As partners, you need to decide at what point do you stop trying”

Starting fertility treatments is a big life decision, more difficult, perhaps, is deciding when to stop. 

“Majority of infertile couples who seek help from fertility specialists achieve pregnancy by simple treatments like ovulation induction, IUI and laparoscopy. Only 10% of such couples need to go further towards IVF treatment. In about 3-4 IVF attempts, nearly 90% of the couples become pregnant and complete their family,” says Pai.  

There’s no singular milestone that couples reach before making the decision to stop trying. It’s different for everyone, in terms of the emotional, physical and financial resources we want to invest in this particular aspect of our life. 

Patel says that when a couple finds themselves at a crossroads of whether to stop fertility treatments or start all over again, other than the question about resources they should also ask themselves: Are you comfortable with the next treatment plans offered by your doctor? Hope is the engine that keeps us moving forward, are you willing to give it one more try? “Evaluating facts of the situation versus your feelings and listening to your inner instincts. Taking a break in between your treatment failures is another option for couples to heal the emotional burnout. This way they can come back more enthusiastically and ensure continuity of treatment rather than ending it.”

One couple may undergo various tests and treatments, do five cycles of IVF before they call it off. Another, like Lekhi and her husband, may decide that twice is enough. 

They felt that their time, attention and finances would be better spent, not on more tests, injections and IVF, but in starting the process of adoption.

*Names changed upon contributor’s request for anonymity.

A note of caution: This article includes personal experiences and inputs from experts and trained professionals. Please consult your healthcare provider to know the best course of treatment to suit your body and needs.